Background/Objectives Little is known about the COVID-19 pandemic and its impact on the quality of life (QoL) of children with cancer, who may be more vulnerable to the pandemic’s effects. This paper examined: (1) associations between COVID-19 exposure and impact on QoL in children with cancer, and 2) potential moderation based on child’s cancer status (i.e., time since diagnosis, on/off treatment). Design/Methods Parents of children with cancer in the US were recruited February-April 2021 via Facebook and Momcology. Parents completed the Covid Exposure and Family Impact Scale a child quality of life measure. Controlling for parent age, income, child age, and child sex, we examined the indirect effect of COVID impact on the association between COVID exposure and child QoL, as well as the moderating role of cancer status. Results Children had lower QoL scores ( M=59.74) than previous reports of QoL in children with cancer ( t(735)=-6.98, p<0.001). Mediation analyses revealed a significant indirect effect (95%CI[-0.47,-0.13]): higher exposure was associated with higher impact ( a=0.47, p<0.001), which was then related to lower QoL ( b=-0.56, p<0.001). Treatment status did not affect this indirect path; however, the association between impact and QoL was stronger as time since diagnosis increased (95%CI[-0.08,-0.001]). Conclusions Parents who report greater COVID impact may also report lower QoL in their children with cancer, especially further from diagnosis. Clinicians should be aware of the negative impact of the pandemic on parents and screen for COVID-related distress. Additionally, results highlight the importance of long-term, family-centered care, regardless of children being on or off treatment.

Background A diagnosis of childhood cancer results in new parent-child communication challenges. Little is known about how communication changes over time after diagnosis or relapse. The objective of this study was to determine the effect of time since diagnosis and relapse on quality of parent-child communication. We hypothesized that there would be a positive correlation between time and quality of parent-child communication. Methods Cross-sectional study in children (7 to 17 years) with relapsed/refractory cancer and their caregivers, who spoke English, were not cognitively impaired, and had internet access. Parents were recruited through Facebook ads. Parents and children completed the Parent-Adolescent Communication Scale (PACS), a 20-item measure of communication quality, with openness and problem subscales. Spearman’s Rho coefficients assessed correlations between PACS scores and time since diagnosis/relapse. Results There was a statistically significant negative correlation between parent PACS scores and time since child’s cancer diagnosis (Spearman’s Rho = - 0.21, p = 0.02), indicating a tendency for overall worsening communication as time since diagnosis increased. There was a positive correlation between the parent PACS problem scores and time since diagnosis (Spearman’s Rho = + 0.22, p = 0.01), indicating more problematic communication as time since diagnosis increased. Correlations of time since relapse and PACS scores were small and not statistically significant. Conclusion Parent-child communication worsens over time following a child’s cancer diagnosis with more communication problems, contrary to our hypothesis. Future studies are needed to evaluate intervention timing to best support parent-child communication beyond the new diagnosis period.